UNASSIGNED: We characterized features of- identified factors associated with- PrEP initiation and discontinuation, and the effects of PrEP initiation on HIV incidence.
UNASSIGNED: Of 2221 participants, 31.8% initiated oral PrEP during study follow-up, with the highest proportion of PrEP initiations in Brazil (83.2%) and the United States (US) (54.2%). Prior PrEP use was associated with PrEP initiation (hazard ratio [HR], 2.22 [95% confidence interval {CI}, 1.25-3.95]). Participants from Switzerland (HR, 0.5 [95% CI, .3-1.0]) and Peru (HR, 0.08 [95% CI, .06-.1]) had lower likelihood of PrEP initiation compared to the US, while participants from Brazil had higher likelihood (HR, 2.6 [95% CI, 2.0-3.3]). In the US, PrEP initiation was lower in areas with higher unmet need for PrEP (HR, 0.9 per 5 units [95% CI, 0.8-1.0]). PrEP initiators had 58% less risk of acquiring HIV than PrEP noninitiators. Among PrEP initiators, 34.4% discontinued PrEP during study follow-up. Brazil had 63% less likelihood of PrEP discontinuation than the US (HR, 0.37 [95% CI, .22-.60]).
UNASSIGNED: When included as standard of prevention in HVTN 704/085, oral PrEP utilization patterns mirrored those observed in real-life settings. Variable effects of oral PrEP on HIV outcomes in clinical trials may be expected based on regional differences in oral PrEP use.
■我们表征了与PrEP启动和停药相关的已识别因素的特征,以及PrEP启动对HIV发病率的影响。
■在2221名参与者中,31.8%的人在研究随访期间开始口服PrEP,在巴西(83.2%)和美国(54.2%)的PrEP初始化比例最高。先前使用PrEP与开始使用PrEP相关(风险比[HR],2.22[95%置信区间{CI},1.25-3.95])。来自瑞士的参与者(HR,0.5[95%CI,.3-1.0])和秘鲁(HR,0.08[95%CI,.06-.1])与美国相比,PrEP启动的可能性较低,而来自巴西的参与者有更高的可能性(HR,2.6[95%CI,2.0-3.3])。在美国,在未满足PrEP需求较高的地区,PrEP的起始率较低(HR,每5个单位0.9个[95%CI,0.8-1.0])。PrEP发起者获得HIV的风险比PrEP非发起者低58%。在PrEP发起人中,34.4%在研究随访期间停止PrEP。巴西停药的可能性比美国低63%(HR,0.37[95%CI,.22-.60])。
■当作为HVTN704/085中的预防标准时,口头PrEP利用模式反映了在现实生活中观察到的模式。根据口服PrEP使用的区域差异,可以预期口服PrEP对临床试验中HIV结局的可变影响。